TOXICOLOGY TIMES (800) 677-7995 www.sdrl.com A FREE Monthly Newsletter for Substance Abuse and Opioid Treatment Volume 5, Issue 7 Programs from San Diego Reference Laboratory July, 2015

Amphetamines (Part 1) Dr. Joseph E. Graas, Scientific Director most often used in inhalers and does not tite, increased stamina and physical energy, Dr. Edward Moore, Medical Director have the central nervous system activity nor increased sexual response/drive, involuntary any addictive properties. All of the com- body movements, increased perspiration, The term “amphetamines” has come to mean pounds that have the structure of hyperactivity, nausea and increased heart rate. a class of endogenous neurotransmitters that phenylethylamine will have this mixture of d This drug is highly addictive and tolerance stimulate the sympathetic nervous system. and l molecules. In the production of these develops quickly. Withdrawal is an extremely This is a broad class of various substituted drugs they are usually noted as a racemic unpleasant experience. A few street names derivatives of phenylethylamine. This grow- mixture, or specifically, as the d or l com- for the drug are amp, speed, crank, dolls and ing class of structurally related molecules may pound. To properly evaluate this family of crystal. also stimulate the sympathetic nervous sys- compounds known as sympathomimetic tem in many different ways, such as affecting amines, amphetamines or phenylethylamine, Methamphetamine was developed by the the re-release of neurotransmitters or pre- it is best done by describing each member of Japanese in 1919 and used during World War venting the re-uptake of neurotransmitters, the class: amphetamine , methampheta- II to help soldiers stay alert and energize hallucinogens, anorectics, bronchodilators mine , phentermine , phenylpropanola- factory workers. Beginning in the 1950’s, it and antidepressants. mine , ephedrine /pseudoephedrine , was used in the United States as a medication cathine , cathinone , methcathinone , Khat , for depression and to treat obesity. In the In the amphetamines class, it is a slight struc- MDA , and MDMA . 1980’s the manufacturing and illicit use of the tural difference that results in two different drug became widespread especially in Califor- conformations (d and l) with very different Amphetamine was first discovered in 1877 nia. The oral use, smoking or injection has biological activity. Carbon atoms will form and exists as a racemic mixture of dextroam- been reported to produce an intense “rush” four single bonds in molecules. The geome- phetamine and levoamphetamine. The first lasting from a couple of hours to half a day. try of this carbon bonding leads to the asym- medical use was in 1930 with the treatment Methamphetamine is believed to result in a metry in a large molecule where each of the of extreme sleep disorders (narcolepsy) and large level of the neurotransmitter dopamine, four bonds is attached to a different group. depression. The first prescription formula- released into areas of the brain that regulate The properties of the molecule are greatly tion of dl-amphetamine was released in 1933 the feeling of pleasure. Long term use can affected by this asymmetry. The molecules as Benzedrine, in the form of an inhalant, to result in addiction and brain damage, which is are noted by the d or l preceding the name of increase nasal blood flow and to enlarge the manifested in violent behavior, anxiety, con- the drug. D-methamphetamine and l- air passages to facilitate better breathing. The fusion and insomnia. Street names are the methamphetamine have very different activi- inhalant was soon discontinued and replaced same, or very similar, to those used for am- ties. D-methamphetamine is a very powerful with less addictive ephedrine, l-amphetamine phetamine. central nervous system stimulant with highly and propylhexedrine. Physical effects of Part 2 of this article will appear in the Au- addictive properties, where as the l isomer is amphetamine abuse include decreased appe- gust issue of Toxicology Times ??? Did You Know ??? Question of the Month The coexistence of both a mental illness and a substance use condi- Question: How often should serum methadone testing be tion is referred to as co-occurring mental and substance use disor- performed? ders. There are no specific combinations of substance use disorders and mental disorders that are defined uniquely as co-occurring dis- Answer: SDRL recommends that all patients in methadone orders. Co-occurring disorders may include any combination of two or more substance use disorders and mental disorders identified in maintenance treatment programs have their serum levels the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition measured at least once per year, ideally during an annual (DSM-5). They are also referred to as having a dual diagnosis. People with a mental health issue are more likely to experience an physical. This will provide baseline values moving forward. alcohol or substance use disorder than those not affected by a men- Other times to consider serum methadone testing include any tal illness. Approximately 8.4 million adults have co-occurring disor- time the patient requests a dose change or when a patient’s ders. Source: SAMHSA urine sample tests negative for methadone metabolite and he/she denies medication misuse. Toxicology Times © 2015 San Diego Reference Laboratory.